HEALTH • WELCOME, ACTIVE PARTICIPANTS!
Welcome to the Sheet Metal Workers’ Health Plan of Southern California, Arizona & Nevada.
Active Health Coverage for Working participants- Your eligibility for benefits is established and continued on a month-to-month basis, and is determined by the number of hours you work each month. Once you have established coverage, you will be eligible for Medical, Dental and Vision benefits.
Depending on your residence, you may have a choice of up to 4 medical plans to choose from.
For the first month of coverage, all eligible participants are automatically covered under the Fee-For-Service PPO medical plan. You have 60 days from your initial eligibility date to elect an HMO or EPO, if you so choose. If you enroll in an HMO or EPO, the Fee-for-Service PPO medical plan will be continued until your HMO/EPO effective date. After 60 days, you will not have the option to switch medical plans until the next Annual Open Enrollment. Once you have elected a medical plan, you may change your election only during the next Annual Open Enrollment. Exceptions are made only if you are enrolled in an HMO and you move outside their service area, so please review this information and choose your medical plan carefully.
Your Prescription Benefits are determined by your medical plan. While enrolled on the Fee-for-Service PPO medical plan, you must use the Express Scripts pharmacy network for all routine and maintenance (mail-order) prescriptions. If you enroll in an HMO/EPO plan, you must use that HMO/EPO for all your prescription needs
Blue View Vision - Regardless of which medical plan you choose, your Vision benefits are a separate benefit available under Blue View Vision. To utilize your benefits, simply make an appointment with a participating Vision Blue View Vision provider. Your provider will then contact Blue View Vision to verify your eligibility. If you need help in locating a Blue View Vision provider, call Blue View Vision at (866) 723-0515, or visit their website at anthem.com.
Beat It! Program - Regardless of which medical plan you choose, you will still have benefits available under the Beat It! Program. If you are enrolled in an HMO, you may choose between the HMO/EPO substance abuse benefits, or use them in combination with the Beat It! Program.
The following IMPORTANT information is outlined in the Summary Plan Description. To avoid a lapse or loss of coverage, please review this information carefully!
- There is a full month between actual hours worked and benefit month. Therefore, hours worked in the month of January will be applied to coverage for the month of March, and so forth. After you have initially established eligibility, 110 hours per month for Plan B participants, or 120 hours per monthfor Plan A participants, is deducted from your hour bank for each month of coverage.
- It is YOUR responsibility to know how many hours are in your hour bank, and when your coverage will terminate. Feel free to contact us to check your status at any time.
- If you are unable to perform your normal Sheet Metal duties due to an injury or illness, you may be eligible for an extension of benefits. You must contact the Administrative Office and complete the necessary form within 30 days of the date of your injury.
- Moving? Please be sure to notify the Administrative Office, in writing, immediately. This will ensure that you do not experience a lapse in coverage, and continue to receive all necessary and important information regarding your health coverage.
If you have any questions, please do not hesitate to contact the Eligibility Department. We are here to assist you!